Outline

Ocular hypertension is defined as abnormally elevated intraocular pressure in the presence of normal visual field and optic disc. The prevalence of ocular hypertension varies in different populations and has been found to be as high as 9.5 %. The significance of ocular hypertension is based on the fact that it may convert to glaucoma and that a distinction between ocular hypertension and glaucoma is indeed difficult. Several studies have been undertaken in order to establish whether or not intraocular pressure lowering therapy may prevent or delay conversion from ocular hypertension to glaucoma. Six different randomized controlled and prospective studies were performed, but showed different results.

Review of literature: Intraocular pressure lowering therapy was able to reduce the ration of conversion from ocular hypertension to glaucoma in some, but not in all studies. The most important risk factors for the conversion are higher intraocular pressure, older age, greater cup-disc-ratio, thinner central corneal thickness and others.

Intraocular pressure lowering therapy can not be recommended for all ocular hypertensive patients. The risk of conversion from ocular hypertension to glaucoma may vary greatly depending on the individual number and severity of risk factors present. In view of the results available, patients may be advised as to their personal risk to convert from ocular hypertension to glaucoma. It appears advisable to discuss this openly with the patient before deciding whether to prefer early treatment - which may be lifelong and, in fact, unnecessary - or to take the risk to develop very early optic disc and visual field changes before installing therapy.